You could just implement enough surge pricing that people/companies work around peak times on their own and build their own storage.
13,583 karma · joined April 23, 2011
Currently working as a principal engineer for a unicorn supply chain startup.
learc83@gmail.com
https://github.com/learc83/
If you took those same people, and magically made them immunologically naive, they would fare better than a random sample.
My concentration was embedded systems but the majority of the class were just regular CS students.
Despite what the author says, this type of interview is definitely something you can train for. If it’s real, and successful the author has essentially created a test for people who have spent a lot of time in competitive programming, or who spent a lot of time on interview prep.
So now you need to charge significantly more than $12 to make up for that. The higher price makes the paid users even more valuable to advertisers. Eventually the service slips in a few ads because it’s just too much money to leave on the table.
Cable TV started as an ad free subscription service. I’m not saying it can’t work, but historically most subscription services don’t stay ad free forever.
Hospitals can provide an itemized bill after the fact. Not before. They also go back and forth with insurance companies multiple times. It's not actually based on the costs to the hospital. The final itemized bill is the end result of complex negotiation. It isn't actually based on cost.
>"who cares about the individual procedures you performed or what a technician's hourly rate is"
Insurance companies don't care what a technician's hourly rate is.
>I'm asking them to tell me what the maximum amount is they want for a standardized procedure. Possible rebates or lower prices that they can't predict are fine. I want a max price for that specific item.
No surgery is standardized. If you literally want the max price, it's going to be so high you'll never be able to pay it. It won't help you. The individual items don't matter--they're fiction.
>Then socialize it. If you want to argue that the free market isn't a good fit for health care, fine. But that's not really an argument for keeping prices secret, it's an argument for socializing health care and taking it off the free market.
It's not. And it should be public. As long as it's not a free market, none of the normally price discovery mechanisms work at any level in the supply chain. There's no way to provide prices upfront. Any attempt to will fail is just a colossal waste of time. Any list of prices you see is going to be an elaborate piece of fiction.
>To those people, to the people who reduced their bills, yes.
Those people didn't actually reduce their bills because of itemized pricing. They would likely have been able to reduce them regardless. They negotiated with the hospital successfully after the fact the same way an insurance company would.
Hospitals are usually willing to negotiate a bill because they'd rather have some money than none. Whether that's knocking off a line item for $500 aspirin, or nocking 10% off off an opaque $5,000 bill makes no difference.
>Which, incidentally, if your position is that health care should be socialized, line-item pricing also helps with that because it makes it obvious that the pricing is screwed up.
Average prices for procedures can be calculated after the fact. They can be useful in the aggregate. For non commoditized services the averages aren't remotely useful for an individual.
Change it to any arbitrary likelihood below 1. The expected value of a drug during the length of the patent maybe arbitrarily greater than the expected value of a drug after that time period due to reasons other than duplication (alternative unrelated treatments etc..). If it is expected that drug will make nearly all of its total value during the length of the patent, then even a 1% chance of duplication means that the expected value of taking a patent is higher.
Such an extreme disparity between expected value during the patent length and after isn't even necessary when you factor in the additional costs of attempting to maintain a trade secret.
>It doesn't change the fact that patents only have a positive net expected value to the recipient in the situations where the public is expected to lose by granting a patent rather than having the knowledge kept as a trade secret for a time. The interests of the applicant and the public are diametrically opposed; if the patent applicant wins, the public loses.
This is wrong because it ignores the additional costs (both direct and indirect) of maintaining the trade secret.
>We've granted a 20-year monopoly
Minor point--most drug patents have an effective date of about 10 years because of the time it takes to bring a drug to market.
>Maintaining tight control over the distribution of the drug only gets you so far, especially when the underlying research is already public knowledge.
Without the potential benefit of patent protection, we'd almost certainly see research become less open to begin with.
>Trade secrets, unlike patents, don't block independent discovery, and only the rarest and most expensive drugs would warrant complete control over the supply chain.
Probably, but those drugs would become immensely more expensive, or the reward available to an individual company for developing them would go down. Every novel drug would likely warrant some extra level of control (and expense).
>though it would reduce the profitability of individual pharmaceutical companies.
The direct cost of maintaining trade secrets would effectively act as a tax on all pharmaceutical companies doing novel drug development. As would the direct cost caused by duplication of drugs during what would have been the patent protection period. Add in the indirect cost of decreased openness, and the only way to maintain the exact same level of drug research we have today without patents would be to increase public funding for drug development.
I think that's probably a better system to be honest.
Cable TV used to be ad free when it started out.
HBO is probably the best counterexample, but if you look at what they’re doing with HBO max, even they might not be able to resist forever.
1. You shouldn't be admitted to a hospital for those minor clear-cut procedures. 2. Hospitals receive public funds to offset the costs of some services. 3. Hospitals are required to provide certain services regardless of the customer's ability to pay.
>Lawyers have a predictable billable rate, personal physicians and doctors often don't.
Laywers will tell you their billable rate, and can give you a semi accurate estimate for simple services. For more complex services their estimates have enormous error bars.
>There's no reason why a hospital shouldn't be able to figure out the cost of minor anesthesia before a scheduled minor surgery. That's not a surprising part of the procedure, that should be something that's fully negotiated with insurance and disclosed to the patient beforehand so they can decide.
If you're talking about local anesthesia sure, but in that case you're unlikely to actually need to be admitted to a hospital unless it's an emergent condition. If you're talking about general anesthesia then there's a reason that an anesthesiologist or a CRNA with many years of training is required to be present.
> Yes, absolutely, you can find tons of stories online about people negotiating smaller bills because itemized bills turn out to include services that they never requested (and in some cases services that were never even actually performed).
Yes but do you have actual data that the benefits are worth the cost? Has it actually driven down health prices in the US overall? Was the additional complexity actually worth it?
>It's also absolutely worthwhile because you're seeing creative line items like $500 for aspirin that prove that the costs of the services aren't being based on market rates.
I think you're not understanding the point of this. You're not going to actually save money by declining to take an aspirin. Of course hospital services aren't based on market rates. Hospitals are required by law to offer certain services regardless of the ability of patients to pay, most patients are insulated from the actual costs through insurance, many patients have zero out of pocket costs, complex procedures are impossible to accurately estimate, and the free market has an inherent problem with extremely price inelastic services.
It's not a free market, and unless we are willing to make drastic changes to society, it never will be. Pricing transparency for hospital commodities is such an insignificant part of health care costs that it's a gigantic waste of everyone's time.
The problem is that when patents are no longer an option trade secrets (or public funding) become essentially the only viable option to pay for the majority of drug research.
If a drug is unique and desirable, forcing doctors, suppliers and patients into contracts that don't allow reverse engineering is the most likely outcome. In extreme cases drug companies could require patients to only be treated in a doctor's office.
In the case of drugs that can't be kept secret, given the time and effort necessary to develop, much of the economic incentive for that research evaporates.
>Patents are thus only viable for those things which would not be expected to remain secret.
That's not how the math works outs. You can easily construct a counter example where a drug has a greater than 50% chance of remaining secret during the length of the patent, yet taking the patent has a greater expected value.
The kinds of easy issues you're talking about don't need to happen in a hospital. You can already go to an outpatient imaging clinic for an x-ray, a dermatologist's office to have a mole removed, or an urgent care to suture a laceration.
If you need emergent care or you want an elective procedure that requires a hospital stay, you're into the realm of custom services with variable pricing.
>This is the exact same argument that hospitals used to use against itemized pricing, and yet it turns out that requiring hospitals to give itemized bills on request has pretty solidly been a good thing for consumers.
Has it? Has it driven down prices? Has the demonstrated value been worth the cost? Or has it just pushed hospitals into creating longer bills with more creative items and charges. Creative line items like $500 for aspirin perhaps?
You could replace patents with trade secrets and have many of the same problems (along with some others).
It most certainly is the norm when purchasing complex custom services.
>A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process.
If a surgeon could keep your chest open on an operating table while they walked you through the process this analogy would work.
>a good explanation of why pricing a surgery or an entire hospital visit may be difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable".
jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront.
As for the price os a single x-ray. I'm sure the average cost of a single x-ray could be calculated. But how much is that worth when the entirety of the hospital visit is going to be a variable cost? If you're only interested in a single x-ray, there are already outpatient imaging clinics that will give you the upfront cost.
There's nothing inherent to Capitalism that prevents variable priced contracts.
>Pretty much every other industry in America has figured out how to put a price tag on the products they sell,
Maybe for mass produced products they have, but certainly not for custom work. You aren't paying for a product but for a custom service. Paying a doctor to fix your body in many cases is more complex than paying someone to build a house, a bridge, or a piece of software. You won't even get an upfront price for something as simple remodeling your kitchen. A contractor estimates that it will cost $20k and then finds that a leak in your attic completely rotted some of the framing, now it's $50k. A builder starts digging the foundation to your house only to discover a huge boulder that has to be moved.
There are parts of medicine that could be made more transparent, but there is an inherent complexity that makes complete or even mostly complete price transparency impossible.
That doesn’t mean that they didn’t need to understand calculus as a prerequisite to other classes where they did learn skills they use frequently.
MDs also aren’t technicians, they are a self regulating group of professionals with a high degree of legally protected autonomy and authority. Individually they make life or death decisions more frequently than anyone else. And as a group they make up regulatory bodies that impact everyone’s medical care. Like lawyers they have a very disproportionate impact on society. I think some amount of general education and general science background is appropriate.
2. Making a decent grade in those classes at an accredited school is a good filter.
3. MDs aren’t just technicians. They are leaders, managers, and ethicists. They have a higher level of legally protected autonomy than nearly any other profession. Given that, I think that 2 years of general education is appropriate. For the same reasons I think general education is appropriate for other professions with a high degree of autonomy, authority, and impact, e.g., civil engineers, lawyers, and teachers (all the teachers reading this are laughing at the autonomy part).
And in the US there is no national high school curriculum, so an extra 2 years for general education isn't a bad idea.
Why not multiply by the probability that you don't die within the next 90 days from some other event, or the probability that the earth doesn't explode within 90 days.
The likelihood that you're infected is both too hard to calculate for a given individual to be useful and, based on current epidemiological models, close enough to 1 over the long term for unvaccinated people that it doesn't make much difference.
The probability used in the model presented is the probability that a random person in the UK will be infected given the same conditions seen in March of 2020 over a 90 day period. It's a useless number. Multiplying the IFR just destroys whatever useful information you could extract from the IFR in the first place.
Since your wife is a nurse, she’s much more likely to be exposed than the average UK resident. I also think even in her case you likely added an extra zero or 2 based on what I’m seeing while playing around with it.
I think what most people want is what’s my risk of death assuming I get it, not that multiplied times the risk of being infected within only the next 90 days.
2.Other study findings suggest that fully or partially vaccinated people who got COVID-19 might be less likely to spread the virus to others. For example, fully or partially vaccinated study participants had 40 percent less detectable virus in their nose (i.e., a lower viral load), and the virus was detected for six fewer days (i.e., viral shedding) compared to those who were unvaccinated when infected. In addition, people who were partially or fully vaccinated were 66 percent less likely to test positive for SARS-CoV-2 infection for more than one week compared to those who were unvaccinated. While these indicators are not a direct measure of a person’s ability to spread the virus, they have been correlated with reduced spread of other viruses, such as varicella and influenza.
https://www.cdc.gov/media/releases/2021/p0607-mrna-reduce-ri...
If I didn't think that the ensuing violence would kill more people than it would save, I would absolutely vote for some level of mandatory vaccination.
Since then multiple studies have shown no increase in infertility.
I’ve been following the book for a while but decided to wait until the print version was out.
However it also wasn’t an order of magnitude less. According to this WSJ report [1], lockdowns took at least 1/4 of the economy offline.
1. https://www.wsj.com/articles/state-coronavirus-shutdowns-hav...
I was very confused for a while until someone asked them about it. Turns out they had purposely created a “head mate” and now insisted on being treated as multiple people.